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Penile Doppler ultrasound study in priapism: A systematic review. Prog Urol 2021; 32:61-69. [PMID: 34229947 DOI: 10.1016/j.purol.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Penile Doppler ultrasound (PDU) is suggested to be an alternative to blood gas analysis (BGA) from the corpora cavernosa in differentiating between high- and low-flow priapisms, with limited supportive evidence. AIM To compare penile Doppler ultrasound study and blood gas analysis in the diagnosis of priapism, through a systematic review of the literature. METHODS Studies were identified by literature search of Medline, Scopus, Cochrane and ClinicalTrials.Gov. Studies were included if their participants had priapism evaluated by Penile Doppler ultrasound, and reported data on the blood gas analysis or pudendal artery angiography (PAA). Two authors independently extracted the articles using predetermined datasets, including indicators of quality. OUTCOMES Correlation of penile Doppler ultrasound with blood gas analysis and pudendal artery angiography. RESULTS Twelve studies were included. Three studies compared Penile Doppler ultrasound to blood gas analysis and pudendal artery angiography. Penile Doppler ultrasound was used as adjunctive to blood gas analysis to differentiate low flow from high flow priapism, guidance for embolization, etiological diagnosis in three studies. Compared to pudendal artery angiography, penile Doppler ultrasound had a sensitivity of 40-100% and a specificity of 73%, to localize vascular injury and anatomical abnormalities (two studies). Penile Doppler ultrasound was also used for the follow-up after the treatment of priapism (two studies). No study reported an impact on functional results or a delay of management due to penile Doppler ultrasound use. CLINICAL TRANSLATION We reviewed evidence on penile Doppler ultrasound study in priapism. Penile Doppler ultrasound study performance was comparable to blood gas from corpus cavernosum. It is recommended to use doppler as an alternative diagnostic tool. STRENGTHS & LIMITATIONS Our systematic review had limitations. Firstly, the number of cases in the included studies was small. Secondly, these studies were all retrospective. Lastly, few data were reported with regards to hemodynamic parameters of penile Doppler ultrasound, and the majority of studies did not describe these in detail. CONCLUSIONS Evidence supports that penile Doppler ultrasound is a reliable way for differentiating high-flow and low-flow priapism. We recommend penile Doppler ultrasound study as an alternative of blood gas analysis from corpus cavernosum, especially when the latter is not available. LEVEL OF EVIDENCE 3.
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Fiore CM, Pellegrino ML, Trivedi MC. Chronic recurrent priapism: A high flow state secondary to an arteriovenous fistula of the corpus cavernosum. Urol Case Rep 2019; 28:101068. [PMID: 31754604 PMCID: PMC6854086 DOI: 10.1016/j.eucr.2019.101068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 12/03/2022] Open
Abstract
Priapism is clinically defined as an erect penis for more than 4 h unrelated to sexual stimulation. There are two main types of priapism-high flow and low flow, based on the pathophysiology. In this case report we will mainly focus on high flow, non-ischemic priapism, which is the less common form. High flow priapism occurs secondary to congenital malformation or from the development of arteriovenous malformation from genital trauma. This case highlights the importance of differentiation and recognition of posttraumatic high flow priapism and unveils the role of selective internal pudendal artery angiography and embolization in its management.
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Affiliation(s)
- Catherine M. Fiore
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Melissa L. Pellegrino
- Division of Hospital Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Meghna C. Trivedi
- Division of Hospital Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
- Corresponding author.
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Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2019; 8:140-149. [PMID: 30987934 DOI: 10.1016/j.sxmr.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow priapism. AIM We collected the most recent available data and summarized the findings. METHODS All literature related to non-ischemic priapism from 2000-2018 from several databases was reviewed, and 105 articles, including any relevant referenced articles, were ultimately included. MAIN OUTCOME METHODS We evaluated modality success rates, need for repeat procedures, and effects on erectile function. RESULTS 237 cases of non-ischemic priapism were evaluated. Approximately 27% of patients underwent observation or medical management as the first treatment modality, whereas 73% underwent intervention without observation or medical management beforehand. Angiographic embolization with temporary agents was the most common intervention and generally resulted in both moderate resolution of non-ischemic priapism and moderate preservation of baseline erectile function. Patients who underwent embolization with permanent agents experienced higher rates of resolution, as well as lower rates of erectile dysfunction (ED). CONCLUSION Most of the literature is in the form of case reports and small case series, thus limiting the quality and quantity of evidence available to draw decisive conclusions. However, from the available data, it is reasonable to presume that patients can undergo a trial of conservative management, then pursue embolization first with temporary agents. The analysis of the data demonstrated ED rates were higher with temporary agents than permanent agents. The literature quotes ED rates as low as 5% when using temporary agents and 39% with permanent agents. Our results were, in fact, the opposite, with higher ED rates when using temporary agents vs permanent (17-33% vs 8-17%). Further studies are required to better characterize the success and outcomes of angioembolization. Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2020;8:140-149.
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Affiliation(s)
- Amanda R Ingram
- The Ohio State University Department of Urology, Columbus, Oho, USA
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Reddy AG, Alzweri LM, Gabrielson AT, Leinwand G, Hellstrom WJG. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health 2018; 36:4-14. [PMID: 29299902 PMCID: PMC5756805 DOI: 10.5534/wjmh.17040] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.
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Affiliation(s)
- Amit G Reddy
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laith M Alzweri
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gabriel Leinwand
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Nabinger GB, Burttet LM, Lucena IRS, Neto BS, Berger M, Rosito TE. Child non-ischemic priapism, a conservative approach: case report and updated review. J Pediatr Urol 2013; 9:e99-101. [PMID: 23287647 DOI: 10.1016/j.jpurol.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/10/2012] [Indexed: 11/18/2022]
Abstract
Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.
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6
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Shrewsberry A, Weiss A, Ritenour CWM. Recent advances in the medical and surgical treatment of priapism. Curr Urol Rep 2010; 11:405-13. [PMID: 20878277 DOI: 10.1007/s11934-010-0142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Priapism often is a urological emergency that requires prompt and aggressive therapy. Over the past several years, research has provided better understanding and new insights into the pathophysiology of this disorder. Subsequently, new treatments have been tried and developed. This report focuses on the latest review of therapy for ischemic and nonischemic priapism.
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Affiliation(s)
- Adam Shrewsberry
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA
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7
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Abstract
Priapism is defined as a persistent penile erection (typically 4 h or longer) that is unrelated to sexual stimulation. Priapism can be classified as either ischemic or nonischemic. Ischemic priapism, the most common subtype, is typically accompanied by pain and is associated with a substantial risk of subsequent erectile dysfunction. Prompt medical attention is indicated in cases of ischemic priapism. The initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. Stuttering (recurrent) ischemic priapism is a challenging and poorly understood condition; new management strategies currently under investigation may improve our ability to care for men with this condition. Nonischemic priapism occurs more rarely than ischemic priapism, and is most often the result of trauma. This subtype of priapism, which is generally not painful, is usually initially managed with conservative treatment.
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9
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Poey C, Guy F, Rabia N, Vergnolle M, Khadji A, Raynaud M, Dutheil A. [Non traumatic high flow priapism: arterial embolization treatment]. ACTA ACUST UNITED AC 2006; 87:115-9. [PMID: 16484933 DOI: 10.1016/s0221-0363(06)73981-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To report cases of non traumatic high flow priapism treated by arterial embolization. MATERIAL AND METHODS Six men presented with non traumatic high flow priapism, the diagnosis was based on colour Doppler ultrasound, cavernous blood gas analysis with arterial blood saturation levels and failed medical or surgical therapy. Four patients had sickle cell disease. The embolization was performed with Gelfoam and was unilateral in one case, bilateral in the other cases. RESULTS Detumescence occurred in a few hours in all cases. One patient had recurrent priapism two years after and was treated by embolization. Transient erectile dysfunction was observed in five cases, permanent in one case. CONCLUSION Arterial embolization is the treatment of choice in high flow priapism with low rate of permanent erectile dysfunction.
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Affiliation(s)
- C Poey
- Service de Radiologie, Clinique St Paul, 97200 Fort de France.
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10
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The modern approach to high-flow priapism. CURRENT SEXUAL HEALTH REPORTS 2006. [DOI: 10.1007/s11930-006-0021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Liguori G, Garaffa G, Trombetta C, Capone M, Bertolotto M, Pozzi-Mucelli F, Belgrano E. High-flow priapism (HFP) secondary to Nesbit operation: management by percutaneous embolization and colour Doppler-guided compression. Int J Impot Res 2005; 17:304-6. [PMID: 15690066 DOI: 10.1038/sj.ijir.3901251] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G Liguori
- Department of Urology, University of Trieste, Trieste, Italy.
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12
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Abstract
Priapism is a relatively uncommon condition that may present as a medical emergency associated with significant pain and anxiety in the veno-occlusive or low-flow variant. Pharmacologic advances and, specifically, the availability of intracavemosal alpha-agonist therapy have dramatically improved the prospects of resolution for patients with low-flow priapism presenting within the first few hours of the acute episode. High-flow priapism is not considered an emergency and treatment measures are typically conservative aimed at preservation of potency. Urologists, radiologists, and other health care personnel caring for the patient with priapism must be familiar with various etiologic factors implicated in low-flow and high-flow priapism to formulate a logical step-care approach. Differentiation of the low-flow from the high-flow state is perhaps the most critical initial diagnostic challenge that determines the sequence of further interventions including surgical shunts in low-flow priapism refractory to medical therapy.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- Division of Ultrasound, Department of Radiology, Case Western Reserve University, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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13
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Lee YC, Shen JT, Shih MC, Chen CC, Chou YH, Huang CH. Bilateral superselective arterial microcoil embolization in post-traumatic high-flow priapism: a case report. Kaohsiung J Med Sci 2003; 19:79-83. [PMID: 12751602 DOI: 10.1016/s1607-551x(09)70453-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Priapism is a prolonged penile erection unrelated to sexual stimulation. High-flow arteriogenic priapism is uncommon and usually occurs after genitoperineal trauma, which may damage a feeding cavernosal artery, leading to an arteriovenous fistula and, occasionally, to an associated pseudoaneurysm. The defects rarely occur bilaterally. Herein, we report successful treatment of high-flow priapism secondary to a traumatic pseudoaneurysm fed from the bilateral cavernosal artery. Diagnosis was made after cavernosal blood gas analysis, color Doppler ultrasonography, and superselective angiography. Treatment consisted of superselective arterial embolization using metallic microcoils and resulted in simultaneous detumescence of the penis with no complications. The patient regained morning erection on the second postoperative day and erectile function remained normal 8 months after treatment. This case shows that bilateral arteriocavernosal fistulae can be successfully treated with superselective arterial embolization without affecting potency and highlights the importance of warning men about the possibility of developing high-flow priapism following a perineal trauma.
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Affiliation(s)
- Yung-Chin Lee
- Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Sadeghi-Nejad H, Seftel AD. The etiology, diagnosis, and treatment of priapism: review of the American Foundation for Urologic Disease Consensus Panel Report. Curr Urol Rep 2002; 3:492-8. [PMID: 12425873 DOI: 10.1007/s11934-002-0103-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Priapism is an important medical condition that requires immediate evaluation, and depending on etiology, may require emergency management. Based on the classification scheme offered by a recent consensus panel, priapism can be subdivided into ischemic and nonischemic types. The nonischemic type, usually the result of perineal trauma, can be treated with conservative therapy, whereas the nonischemic type, which arises from many varied causes, mandates immediate intervention. Corporal fibrosis and permanent erectile dysfunction can result from ischemic priapism that fails to resolve with therapy.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- Department of Urology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5046, USA
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15
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HATZICHRISTOU DIMITRIOS, SALPIGGIDIS GEORGIOS, HATZIMOURATIDIS KONSTANTINOS, APOSTOLIDIS APOSTOLOS, TZORTZIS VASILIOS, BEKOS ATHANASIOS, SARIPOULOS DIMITRIOS. Management Strategy for Arterial Priapism: Therapeutic Dilemmas. J Urol 2002. [DOI: 10.1097/00005392-200211000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Hatzichristou D, Salpiggidis G, Hatzimouratidis K, Apostolidis A, Tzortzis V, Bekos A, Saripoulos D. Management strategy for arterial priapism: therapeutic dilemmas. J Urol 2002; 168:2074-7. [PMID: 12394712 DOI: 10.1016/s0022-5347(05)64299-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We present 7 cases of arterial high flow priapism and propose management algorithms for the condition. MATERIALS AND METHODS We studied 2 children and 5 adults with posttraumatic arterial priapism. Blood gas analysis and color Doppler ultrasonography of the corpora cavernosa confirmed the diagnosis in 4 adults, while 1 patient had already undergone cavernous artery ligation in elsewhere. In the children perineal compression resulted in detumescence, a sign that is proposed to be indicative of the diagnosis of arterial priapism (piesis sign) complementing physical examination. Mechanical compressive force was applied to the perineum of 1 boy, while the other received a watchful waiting program. All adults participated in an observation regimen except 1, who decided to undergo immediate embolization of the internal pudendal artery. RESULTS Perineal compression led to the resolution of priapism in 1 child, while spontaneous resolution was noted in the other. An adult noticed spontaneous penile detumescence 3 to 4 months after trauma, which was attributable to site specific venous leakage and decreased, inflow in the contralateral cavernous artery. The patient underwent venous surgery and is on an intracavernous injection regimen. Successful embolization of the internal pudendal artery was performed immediately in 1 man and in the other 4 months after trauma due to social inconvenience. Adult patient 3 is still on the watchful waiting protocol (42 months), while the one who underwent cavernous artery ligation is receiving treatment for erectile dysfunction. CONCLUSIONS Absent of long-term damaging effects of arterial priapism on erectile tissue combined with the possibility of spontaneous resolution or progressive concomitant hemodynamic abnormalities associated with blunt perineal trauma are suggestive of the introduction of an observation period in the management algorithm of high flow priapism. Such a period may help avoid unnecessary intervention and determine the impact of priapism on patient personal life. Perineal compression may be also added as part of the physical examination as a sign specifically indicative of arterial priapism.
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Affiliation(s)
- Dimitrios Hatzichristou
- Department of Urology, Aristotle University of Thessaloniki and Hippocration General Hospital, Greece
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Mizuno I, Fuse H, Junicho A, Kageyama M. An experience of percutaneous embolization to post-traumatic arterial priapism in a child. Int Urol Nephrol 2002; 32:695-7. [PMID: 11989567 DOI: 10.1023/a:1015020821044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report an experience of percutaneous transcatheter embolization to posttraumatic arterial priapism in a child. Priapism was successfully treated with this method. Angiography with subsequent selective embolization should be considered to be the treatment of choice for arterial priapism in children as well as in adults when less invasive treatments fail.
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Affiliation(s)
- I Mizuno
- Department of Urology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan.
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Suzuki K, Nishizawa S, Muraishi O, Fujita A, Hyodoh H, Tokue A. Post-traumatic high flow priapism: demonstrable findings of penile enhanced computed tomography. Int J Urol 2001; 8:648-51. [PMID: 11903696 DOI: 10.1046/j.1442-2042.2001.00391.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Post-traumatic high flow priapism is a rare disease. A review of English published reports revealed 63 cases. Enhanced computed tomography (CT) of the penis has not previously been used as a diagnostic method for post-traumatic high flow priapism. We present a case of post-traumatic high flow priapism diagnosed with enhanced CT of the penis. Additionally, diagnostic modalities for post-traumatic high flow priapism are discussed with review of published work.
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Affiliation(s)
- K Suzuki
- Department of Urology, Jichi Medical School, Tochigi, Japan.
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PARK JONGKWAN, JEONG YOUNGBEOM, HAN YOUNGMIN. RECANALIZATION OF EMBOLIZED CAVERNOSAL ARTERY: RESTORING POTENCY IN THE PATIENT WITH HIGH FLOW PRIAPISM. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66271-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- JONG KWAN PARK
- From the Departments of Urology and Radiology, Medical School and Institute for Medical Sciences, Chonbuk National University and Research Institute of Clinical Medicine, Chonbuk National University Hospital Chonju, Chonbuk, Korea
| | - YOUNG BEOM JEONG
- From the Departments of Urology and Radiology, Medical School and Institute for Medical Sciences, Chonbuk National University and Research Institute of Clinical Medicine, Chonbuk National University Hospital Chonju, Chonbuk, Korea
| | - YOUNG MIN HAN
- From the Departments of Urology and Radiology, Medical School and Institute for Medical Sciences, Chonbuk National University and Research Institute of Clinical Medicine, Chonbuk National University Hospital Chonju, Chonbuk, Korea
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PARK JONGKWAN, JEONG YOUNGBEOM, HAN YOUNGMIN. RECANALIZATION OF EMBOLIZED CAVERNOSAL ARTERY:. J Urol 2001. [DOI: 10.1097/00005392-200106000-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Advances in the pharmacotherapeutic options available to treat erectile dysfunction over the past decade have transformed the field of impotence. The initial foray into this field with intracavernous injections of papaverine rapidly expanded the number of men seeking attention for priapism, a previously rare clinical condition. The recent widespread use and acceptance of oral agents for the treatment of erectile dysfunction, with a reduced incidence of priapism has decreased the number of men at risk for injection-related prolonged erections. The use of recreational drugs (cocaine) and perineal trauma leading to presentations of priapism seem to be rising in incidence. The urologist remains the consultant-specialist ultimately responsible for these men and should be cognizant of the array of treatments described for this condition. Early determination of the state of corporal oxygenation is essential and will define the optimal management approach. A wide range of medical conditions and risk factors may be etiologic and should be elicited from the patient at the initial interview. Low-flow ischemic priapism requires a rapid resolution, often achieved through use of alpha-agonists orally or by direct injection into the penile circulation, whereas nonischemic priapism can be treated more conservatively. Research into this condition has only recently been initiated. Through greater understanding of the pathophysiology of priapism, the clinician may become armed with etiology-specific medical alternatives providing timely detumescence for men with prolonged erections.
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Affiliation(s)
- S E Pautler
- Division of Urology, University of Western Ontario, London, Ontario, Canada
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22
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Majeed S, Schor JA, Jacobson S, Jagoda A, Mahadeo R. Refractory priapism of unknown etiology in a pediatric patient. Pediatr Emerg Care 2000; 16:347-51. [PMID: 11063367 DOI: 10.1097/00006565-200010000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Priapism is a urologic emergency that can occur in any age group and every patient should receive prompt urologic consultation. Management of priapism is based on the recognition of underlying pathophysiology; ready differentiation between high-flow and low-flow priapism; reversal of any potential precipitating factors; the use of corporal aspiration irrigation combined with intracavernosal alpha adrenergic therapy; and when necessary, a shunting procedure. Delay in recognition or treatment can be crucial as the incidence of long-term complication rises substantially with the duration of the priapism.
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Affiliation(s)
- S Majeed
- Department of Emergency Medicine, New York Hospital Medical Center of Queens, Flushing 11355, USA
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23
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Goto T, Yagi S, Matsushita S, Uchida Y, Kawahara M, Ohi Y. Diagnosis and treatment of priapism: experience with 5 cases. Urology 1999; 53:1019-23. [PMID: 10223499 DOI: 10.1016/s0090-4295(98)00650-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Priapism is a rare disease, but needs early intervention and appropriate management. We present 5 cases, 2 of nonischemic high-flow priapism and 3 of ischemic low-flow priapism. METHODS Focusing on the differential diagnosis of priapism between the nonischemic high-flow type and the ischemic low-flow type, we reviewed the medical records of 5 patients. RESULTS Of the examinations carried out, cavernosography, blood gas analysis of cavernosal blood, color Doppler ultrasound, and internal pudendal arteriography were useful in differentiating the type of priapism. Complete detumescence of the penis in 2 cases of high-flow priapism and 3 cases of low-flow priapism was achieved by selective embolization with gelform and by glandular-cavernosal shunting, respectively. No recurrence was observed in any patient, and postoperative erectile function was preserved in 4 patients and is unknown in 1. CONCLUSIONS These results indicate that angiographic studies provide the most reliable information for the differentiation of the type of priapism. However, color flow Doppler ultrasound and cavernosal blood gas determination can obviate the need for angiographic studies and are noninvasive. Although conservative treatment or even expectant management may be feasible with high-flow priapism, aggressive treatment should be carried out for low-flow priapism immediately after initial treatment fails to achieve detumescence of the penis. Selective embolization of the internal pudendal artery may be the treatment of choice for patients with high-flow priapism.
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Affiliation(s)
- T Goto
- Department of Urology, Faculty of Medicine, Kagoshima University, Japan
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Kerlan RK, Gordon RL, LaBerge JM, Ring EJ. Superselective microcoil embolization in the management of high-flow priapism. J Vasc Interv Radiol 1998; 9:85-9. [PMID: 9468400 DOI: 10.1016/s1051-0443(98)70488-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- R K Kerlan
- Department of Radiology, University of California, San Francisco, 94143-0628, USA
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OYAMADA T, MIYAJIMA K, KIMURA Y, KIKUCHI M, NAKANISHI S, YOSHIKAWA H. Priapism Possibly Caused by Spinal Nematodiasis in a Stallion. J Equine Sci 1997. [DOI: 10.1294/jes.8.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Toshifumi OYAMADA
- Department of Veterinary Pathology, School of Veterinary Medicine and Animal Sciences, Kitasato University, Higashi 23-35-1, Towada-shi, Aomori 034-8628, Japan
| | - Katsuhiro MIYAJIMA
- Department of Veterinary Pathology, School of Veterinary Medicine and Animal Sciences, Kitasato University, Higashi 23-35-1, Towada-shi, Aomori 034-8628, Japan
| | - Yoshinori KIMURA
- The Japan Bloodhorse Breeders' Association, Shinbashi 4-5-4, Minato-ku, Tokyo 105-0004, Japan
| | - Motohiro KIKUCHI
- Department of Theriogenology, School of Veterinary Medicine and Animal Sciences, Kitasato University, Higashi 23-35-1, Towada-shi, Aomori 034-8628, Japan
| | - Shingo NAKANISHI
- The Japan Bloodhorse Breeders' Association, Shinbashi 4-5-4, Minato-ku, Tokyo 105-0004, Japan
| | - Hiroyasu YOSHIKAWA
- Department of Veterinary Pathology, School of Veterinary Medicine and Animal Sciences, Kitasato University, Higashi 23-35-1, Towada-shi, Aomori 034-8628, Japan
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